Displaying all 11 publications

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  1. Ch'ng LS, Amzar H, Ghazali KC, Siam F
    Clin Radiol, 2018 03;73(3):321.e11-321.e16.
    PMID: 29174175 DOI: 10.1016/j.crad.2017.10.016
    AIM: To review computed tomography (CT), ultrasound (US), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiogram (PTC) appearances and their diagnostic value in hepatic tuberculosis.

    MATERIALS AND METHODS: The imaging studies for 12 patients with biopsy-proven hepatic tuberculosis from January 2012 till March 2014 were reviewed retrospectively. These cases were confirmed via ultrasound-guided biopsy.

    RESULTS: The patients were aged 24-72 years. Four patients had parenchymal tuberculosis only and eight patients had mixed parenchymal and biliary duct involvement. The parenchymal tuberculosis patients showed poorly enhancing, hypodense nodules on CT with central calcification and adjacent dilated intrahepatic ducts. Most patients had multiple lesions except for two patients with a single lesion. The size of the lesions ranged from 0.5 to 6 cm. Seven patients with biliary duct involvement showed a hilar strictures involving the intrahepatic ducts and common bile duct. Nine of the patients showed hilar stricture with atrophy of the ipsilateral lobe of the liver and compensatory hypertrophy of the contralateral lobe. Hepatolithiasis was seen in five patients. Tuberculous lung involvement was seen in seven patients.

    CONCLUSION: The presence of calcified and hypodense nodules with biliary duct dilatation associated with lobar atrophy were the most consistent features of hepatic tuberculosis, especially in the presence of active lung disease.

  2. Ch'ng LS, Zaki Z, Sobri Muda A
    J Interv Med, 2023 Nov;6(4):176-179.
    PMID: 38312133 DOI: 10.1016/j.jimed.2023.09.003
    OBJECTIVE: To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer (EVOH) liquid embolic agent Squid (Emboflu, Switzerland) for the treatment of brain arteriovenous malformations.

    MATERIALS AND PROCEDURES: Between April 2015 and July 2017, 46 embolization treatments for brain arteriovenous malformations (BAVM) were performed in 25 patients using two Squid formulations (18 and 12). Six female and 19 male patients with a mean age of 34 years (range, 9-62 years) were included. A total of 46 procedures were performed. The BAVMs were classified as Spetzler-Martin grade II in 4 procedures, III in 27 procedures, and 1V in 15 procedures. Among the 25 patients, 15 presented with hemorrhage, 5 with seizures, and 5 with headache and neurology. The BAVMs were located in the temporal lobe in 5 patients, parietal lobe in 7 patients, frontal lobe in 3 patients, posterior fossa in 6 patients, basal ganglia in 3 patients, and parasagittal lobe in 1 patient.

    RESULTS: The obliteration rate of the BAVMs ranged from 10% to 100%, with a mean of 33%. Most patients underwent their first or second embolization procedure. Four patients (8%) developed intracranial bleeding post-procedure, with one death (2%). One patient (2%) experienced a seizure during the procedure; however, no intracranial bleeding was observed. Seven patients (15%) experienced perforations during catheter manipulation. One case (2%) of a fractured catheter was recorded, but no significant complications were observed. The average volume of copolymer injected was 0.6 ​ml per nidus. Thirteen procedures used the Squid-12 formulation, 29 procedures used the Squid-18 formulation, and 3 procedures used a combination of Squid-12 and -18 formulations.

    CONCLUSION: Squid is a safe and effective embolic agent for treating BAVMs.

  3. Sidney Ong CL, Ch'ng LS, Aida Bt AA
    Med J Malaysia, 2018 10;73(5):330-331.
    PMID: 30350816 MyJurnal
    Coarctation of the aorta (CoA) is present in 0.4% of live births and in 7% of patients with congenital heart disease. While there may be florid presentations of congestive heart failure in the neonatal period, the diagnosis during adulthood is often delayed. We encountered a 20-year-old woman who was discovered to be hypertensive on routine check-up. Following bilateral abnormal renal doppler sonography, MR angiogram revealed a short-segment stenosis of the descending thoracic aorta. Review of her chest radiograph showed a small aortic knuckle. This case highlights an unconventional algorithm in diagnosing aortic coarctation in adulthood.
  4. Ch'ng LS, Tazuddin EEM, Young B, Ali AFM
    BJR Case Rep, 2016;2(2):20150306.
    PMID: 30363592 DOI: 10.1259/bjrcr.20150306
    Radiofrequency ablation (RFA) of a hepatic tumour is an established treatment option with an acceptable complication rate. Formation of a pseudoaneurysm after RFA of liver metastasis is an uncommon complication. We report the case of a 69-year-old female patient developing a hepatic pseudoaneurysm after RFA of liver metastasis. On a follow-up CT scan 6 weeks later, there was spontaneous resolution of the pseudoaneurysm. Hepatic pseudoaneurysms are usually treated owing to the risk of rupture. Invasive procedures or conservative management of an asymptomatic hepatic pseudoaneurysm is still the subject of debate. The spontaneous resolution of a hepatic pseudoaneurysm in our patient suggests that an asymptomatic pseudoaneurysm maybe observed for resolution instead of being treated at presentation.
  5. Ch'ng LS, Toh CC, Sathiyananthan JR, Malek R
    Int Urol Nephrol, 2022 Mar;54(3):509-515.
    PMID: 35080681 DOI: 10.1007/s11255-022-03105-8
    PURPOSE: Stent encrustation is not uncommonly encountered with a high number of ureteric stents. The exact pathophysiology is not well understood. Therefore, we investigated the relationship between the use of sodium citrate and likelihood of stent encrustation.

    METHODS: This prospective, randomised, intervention study was conducted between October 2018 and October 2019 in a tertiary hospital. Overall, 115 patients with ureteral stents that were inserted after lithotripsy surgeries were recruited. The study subjects were randomised into two groups: one group was administered sodium citrate (Utix sachets) three times per day until stent removal (intervention group), and the second group was not administered Utix sachets (control group). Stents were removed after 1 month and inspected under macroscopic visualisation from the proximal to distal end for any crystallisation; a second inspection was done with a 60 × magnification lens. Any crystallisation observed was considered to be encrustation.

    RESULTS: Patients who had Utix sachets post-insertion of a ureteric stent constituted 50.4% of the study cohort. The rate of encrustation in the control group was 52.6%. In the intervention group, the rate of encrustation was 46.6%. The difference was not statistically significant with the chi-squared test (p value, 0.514).

    CONCLUSION: Alkaline citrate medications had no significant effect on stent encrustation rate. More studies are needed to elucidate different agents and their roles in reducing stent encrustation as it incurs high morbidity.

  6. Fazdlin ARN, Rizuana IH, Ch'ng LS
    Diagnostics (Basel), 2023 Aug 16;13(16).
    PMID: 37627952 DOI: 10.3390/diagnostics13162693
    Post-traumatic vertebral arteriovenous fistula (vAVF) caused by motor vehicle accidents (MVA) is a rare condition in which there is abnormal communication between the vertebral artery and its adjacent veins. In a post-MVA setting, it is commonly associated with vertebral body fracture. In this paper, we report a case of a 19-year-old girl with a complete C2/C3 anterior and posterior ligament tear post MVA without any cervical bony injury. Initial plain computed tomography (CT) cervical scan showed a prevertebral hematoma. A CT angiogram (CTA) raised the suspicion of a pseudo-aneurysm at the right posterior C3 vertebral body. Further imaging with magnetic resonance imaging (MRI) demonstrated traumatic AVF at the C2/C3 level involving the V2/V3 right vertebral artery to the vertebral venous plexus. Digital Subtraction Angiography (DSA) further revealed a transected right vertebral artery at the C2/C3 level with an arteriovenous fistula and an enlarged vertebral venous plexus. The fistulous communication was successfully occluded with coils from a cranial and caudal approach to the transected segment right vertebral artery, with a total of eight coils. Post-MVA vertebral arteriovenous fistula (vAVF) is a rare sequela of vertebral bony injury at the cervical region, and is an even rarer association with an isolated ligamentous injury, whereby endovascular treatment with ipsilateral vertebral artery closure is a feasible treatment of vAVF.
  7. Zahari KM, Mohamad Hatta NS, Ain Masnon N, Ch'ng LS
    BMJ Case Rep, 2023 Aug 29;16(8).
    PMID: 37643820 DOI: 10.1136/bcr-2023-254999
    We report a rare, potentially sight-threatening ocular complication due to central venous stenosis related to a previous site of haemodialysis catheter. A dialysis-dependent woman in her 60s presented with left eye redness for 1 month followed by a remarkably prominent vessel on the left upper eyelid for 2 weeks. Examinations found left eyelid oedema with prominent venous dilatation on the upper eyelid as well as left eye mild proptosis, conjunctiva injection with corkscrew vessels, raised intraocular pressure, and dilated and tortuous retina vessels. Central thoracic venogram showed total occlusion on the left brachiocephalic vein with retrograde reflux to the jugular vein. An endovascular percutaneous transluminal balloon angioplasty was performed for the left brachiocephalic vein stenosis, which resolved the orbital, facial and neck venous congestion. The patient remained asymptomatic after 1 year.
  8. Ch'ng LS, Bux SI, Liam CK, Rahman NA, Ho CY
    Korean J Radiol, 2013 Sep-Oct;14(5):859-62.
    PMID: 24043987 DOI: 10.3348/kjr.2013.14.5.859
    Pulmonary alveolar microlithiasis (PAM) is a rare chronic disease with paucity of symptoms in contrast to the imaging findings. We present a case of a 24-year-old Malay man having an incidental abnormal pre-employment chest radiograph of dense micronodular opacities giving the classical "sandstorm" appearance. High-resolution computed tomography of the lungs showed microcalcifications with subpleural cystic changes. Open lung biopsy showed calcospherites within the alveolar spaces. The radiological and histopathological findings were characteristic of PAM.
  9. Ch'ng LS, Mahfudz AS, Azman H, Zainal Alam MM, Saib E, Rosaland NSA, et al.
    Br J Radiol, 2024 Sep 10.
    PMID: 39254598 DOI: 10.1093/bjr/tqae184
    INTRODUCTION: Fluoroscopic guided procedures are a mainstay for Interventional Radiology (IR) procedures. Practice is needed for the novice to interpret fluoroscopic images and simultaneously perform the procedure hands-on as well as control the foot pedal to screen. We describe the development of a training simulation model which simulates the human kidney, ureter and bladder.

    METHOD: Stereolithography (SLA) 3D Print technology using SLA resin and Anycubic SLA printer were employed. A plastic tubing was used to connect the 3D printed kidney and bladder as the ureter. This simulation model permits fluoroscopic guided filling of "pelvicalyceal system" with contrast as well as ureteric stenting, guidewire and drainage catheter manipulation. Effectiveness of the model to attain skills for nephrostomy exchange and ureteric stenting was obtained via questionnaire from trainees prior to and after utilising the model.

    RESULT: The 3D printing simulation model of the kidney, ureter and bladder system enable trainees to perform nephrostomy exchange, nephrostogram and antegrade stenting. Participants felt more confident to perform the procedures as they were more familiar with the procedure. Besides that, participants felt their wire and catheter manipulation skills have improved after using the simulation model.

    CONCLUSION: Neph-ex simulation model is safe and effective for hands-on training in improving proficiency of fluoroscopy-guided nephrostomy exchange and antegrade ureteric stenting.

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